Gynecological Cancers

Gynecological cancers at a glance

• Gynecologic cancers are those that originate from female reproductive organs.
• Some examples of these include uterine (also sometimes described as endometrial), ovarian, cervical, vaginal, vulvar cancer and, more uncommonly, fallopian tube cancer.
• Understanding symptoms and risk factors of gynecological cancers may help a woman know when to seek medical evaluation and potentially lead to early detection, although symptoms vary for each type and also differ among individual women.
• Unusual or postmenopausal vaginal bleeding is typically an indication to see a doctor for further investigation, in case this is related to cancer.
• Treatment varies by the type and extent of the gynecological cancer, but may include chemotherapy, radiation and/or surgery, or often a combination approach.
• At cCARE, we have a multidisciplinary approach in treating gynecologic cancers, with radiation oncologists, medical oncologists and a dedicated gynecologic oncologist specialist.

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What is gynecological cancer?

Gynecologic cancer occurs through the uncontrolled growth of cells that starts in a woman’s reproductive organs. The Centers for Disease Control and Prevention (CDC) lists the most common types of gynecological cancers as uterine, ovarian, cervical, vaginal and vulvar, which begin in those specific reproductive organs. Gynecologic cancer can also originate from the fallopian tubes, although rarer.

Signs and symptoms will vary, along with different sets of risk factors and prevention strategies.

The goal of this awareness is early detection, which may result in more successful treatment and better outcomes. Following are the primary types of gynecological cancers, risk factors, symptoms and treatment options.

Uterine cancer/endometrial cancer

Uterine cancer, which originates in the uterus (womb), is the most common gynecological cancer among women in the United States. The inner lining of the uterus is called the endometrium and over 90% of the time this is where the cancer originates. For this reason, these are also described as endometrial cancers. A less common form of uterine cancer is uterine sarcoma, and these may arise from the muscles or connective tissue of the uterus.

Risk factors for uterine cancer include:

• Increasing age
• Having experienced early onset menstruation (age 11 or younger)
• Late menopause (typically age 55 or older)
• Infertility
• Not having had children
• Polycystic ovary syndrome (PCOS)
• Obesity
• Hereditary genetic syndromes

What women can do

There are no screening tests to find uterine cancer early, but post-menopausal bleeding is typically a red flag to seek care and further investigation by a physician. Women at average risk and with no symptoms should tell their doctor about unusual discharge, abnormal vaginal bleeding (particularly any bleeding occurring after menopause) or spotting. In addition, there are certain hereditary genetic syndromes that may predispose to increased risk for uterine or endometrial cancer. Women with a strong family history of cancer may be eligible for genetic screening.

Cervical cancer

Cervical cancer originates in the woman’s cervix, which is the passage connecting the vagina and the uterus. Cervical cancer is unique in that it is one of only a few cancers that is highly preventable through a vaccination against the human papillomavirus (HPV). Pap smears are used to screen for this cancer.

Having certain types of HPV infection is the most significant risk factor for cervical cancer. HPV may be transmitted by having skin-to-skin contact through vaginal, anal or oral sex with a person infected by HPV.

What women can do

• Get vaccinated against HPV (depending on age, as this is now typically offered at a young age for better prevention)
• Use condoms during sex
• Don’t smoke
• Make sure they are up to date for their Pap smears and early screening for HPV, which can aid in prevention by detecting precancerous cells in the cervix before the cells become cancerous tumors

Ovarian cancer

Ovarian cancer may occur on one or both of the ovaries, which are located on either side of the uterus. Unfortunately, there is no good screening method for ovarian cancer at present and due to this, it is often not detected until in late stage. Ovarian cancer is also the gynecologic cancer that causes the most deaths.

Risk factors include:

• Never having children or having a first child after age 35
• Having used estrogen hormone replacement therapy
• Hereditary/genetic predisposition or a family history of ovarian or other cancers such as breast cancer

What women can do

There are no screening tests for women who are not considered at high risk of ovarian cancer. A pelvic exam is typically part of a woman’s regular medical workup. Women should see a doctor if they experience these symptoms for more than a few weeks: abdominal pain, abdominal swelling with loss of weight, digestive problems and feeling the need to urinate all the time.

Vaginal cancer

The vagina is the tube-like tissue that connects the cervix to external genitals, and vaginal cancer can arise from the lining of this surface. Types of vaginal cancers are related to the kinds of cells the cancer arises from. Examples of these are squamous, adenocarcinoma, melanoma and sarcoma.

Risk factors for vaginal cancer include:

• Older age
• Smoking
• Vaginal adenosis (areas of the vagina lined by glandular cells instead of squamous cells)
• Exposure to diethylstilbestrol (DES) in utero (for example, women whose mothers took this medication when they were pregnant)
• Having an HPV infection
• Having human immunodeficiency virus (HIV)

There may be no symptoms in the early stages of vaginal cancer and there is no specific screening beyond a usual pelvic exam. When they do present, symptoms include abnormal vaginal bleeding, a lump, pain from urination or sexual intercourse, and constipation. When detected early, cure rates for vaginal cancer are high. In later stages it is harder to treat and cure.

What women can do

• Avoid HPV infection by using a condom
• Get the HPV vaccine (depending on age, typically given at a younger age)
• Stop smoking
• Make sure they are up to date with their Pap smears and HPV testing. These usually are more focused on cervical cancer but they typically include a pelvic exam that includes visualization of the vagina.

Vulvar cancer

The vulva is the outer part of a woman’s genitals and includes the vaginal opening and the skin folds (labia majora and labia minora) around the vagina and the clitoris. Vulvar cancer can originate from abnormal cells called vulvar intraepithelial neoplasia (VIN), which grow on the vulvar skin over a long time and develop into cancer if not detected and treated. There are also other types of vulvar cancer including melanoma, but these are more rare.

Risk factors include:

• Older age
• Smoking
• HPV infection
• HIV infection
• VIN
• Lichen sclerosus

What women can do

Women should seek an evaluation if they have any problems with vulvar chronic itching, burning or bleeding, discolored vulvar skin, rashes, sores, and pelvic pain during urination and intercourse. A biopsy may be the next step for diagnosis if there is an abnormality found on examination.

Other subtypes

Other types of gynecological cancers exist, including primary peritoneal cancer and fallopian tube cancer. We ask that women please talk to their physician for more information as needed.

Gynecologic cancer treatments

Our treatments for gynecologic cancers vary according to different factors. These include the type of cancer, its stage and location, the specific health of the woman, as well as her individual goals. Our providers will discuss with patients all aspects of treatment options, including risks, side effects and effectiveness.

For gynecological cancers we may utilize one or more treatment options, from the more traditional cancer treatments to newer advanced therapies. Depending on the specific situation and cancer, these are sometimes combined.

• Chemotherapy
• Surgery
• Radiation therapy
• Targeted therapy
• Hormone therapy
• Immunotherapy
• Complimentary & integrative medicine